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Applying STAAR interventions in incremental bundles: improving post-CABG surgical patient care
Ondrea L Bates1, Nancy O'Connor, Deborah Dunn
1Administrator, Senior VP Patient Care Continuum and CNO, Allegiance Health, Jackson, MI.
Insights
Implementing targeted interventions significantly reduced 30-day readmission rates for coronary artery bypass surgery (CABG) patients. Quality improvement initiatives, like the STate Action on Avoidable Rehospitalizations (STAAR) program, enhance patient care and lower hospital readmissions.
Area of Science:
- Cardiovascular Surgery
- Healthcare Quality Improvement
- Patient Readmission Reduction
Background:
- High 30-day readmission rates after coronary artery bypass surgery (CABG) contribute to increased healthcare costs.
- National initiatives like the Patient Protection and Affordable Care Act and the STate Action on Avoidable Rehospitalizations (STAAR) program aim to reduce these readmissions.
Purpose of the Study:
- To evaluate the impact of STAAR interventions, specifically teach-back education and pre-discharge appointment scheduling, on 30-day readmission rates in CABG patients.
- To assess the effect of these interventions on the patient experience of care.
Main Methods:
- A quantitative comparative study involving 189 post-CABG patients over two years.
- Comparison of 30-day readmission rates and patient-reported experience of care before and after intervention implementation.
Main Results:
- The 30-day readmission rate decreased from 25.8% in the preintervention group to 12.0% in the postintervention group.
- Chronic lung disease was the only demographic/health characteristic significantly related to readmission in the postintervention group.
Conclusions:
- Targeted interventions, including teach-back and proactive appointment scheduling, effectively reduce 30-day readmissions for CABG patients.
- Incremental, bundled implementation of quality improvement initiatives is a successful strategy for lowering post-CABG readmission rates and improving patient care experience.
Background:
Rehospitalization within 30 days of discharge after coronary artery bypass surgery (CABG) is a contributing factor to higher-than-acceptable overall hospital readmission rates throughout the United States. CABG rehospitalizations are of such concern that they are specifically targeted for action in 2015 under the Patient Protection and Affordable Care Act (2010). The phenomenon of increasing readmission rates has prompted the Institute for Healthcare Improvement to devise the Triple Aim initiative and the STate Action on Avoidable Rehospitalizations (STAAR) initiative to reduce 30-day readmission rates nationally.
Aims:
This study explored the impact of implementing STAAR interventions delivered as part of a quality improvement project in incremental bundles on 30-day readmission rates and the experience of care in CABG patients. Specifically, the use of the teach-back patient education method and the scheduling of follow-up cardiology appointments prior to discharge using existing staff were examined.
Methods:
A quantitative comparative study was conducted with 189 post-CABG patients at a tertiary care facility in the United States over a 2-year period, comparing outcomes between the group of patients prior to implementation of the STAAR interventions and those who later received them. Outcome variables included 30-day readmission rate and patient perception of experience of care.
Results:
The overall 30-day readmission rate for CABG patients in the postintervention group was decreased to 12.0%, compared to 25.8% in the preintervention group. Of the demographic and health characteristics explored, only chronic lung disease was significantly related to 30-day readmission rates, and only in the postintervention group.
Linking Evidence To Action:
Thirty-day readmission rates among CABG patients can be reduced and the experience of care can be enhanced through the use of targeted interventions utilizing existing staff and resources. The deliberate incremental implementation of bundled initiatives is an effective strategy in reducing 30-day readmissions in post-CABG patients.
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